Clinical Thresholds for Visceral Adiposity Accumulation: A Comparative Analysis in Sex-, Age-, and BMI-Matched Black and White Adults.

OBJECTIVES: This study aimed to prospectively identify visceral adipose tissue (VAT) accumulation thresholds in a cohort of sex-, age-, and BMI-matched non-Hispanic White and Black adults using a range of commonly employed whole-body and abdominal-specific adiposity measures associated with chronic disease risk. METHODS: A total of 344 non-Hispanic White (n = 172) and Black adults (n = 172) matched for sex, age, and BMI completed anthropometric and DXA-based body composition assessments. Anthropometric measures included BMI, waist circumference, waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR). DXA was used to quantify VAT, subcutaneous adipose tissue (SAT), body fat percentage (BF%) across the whole body, trunk, and android region, and the android-to-gynoid BF% ratio. Segmented linear regression was used to identify significant sex- and race-specific VAT thresholds for each variable-defined as the inflection points where the relationship between VAT and each variable significantly changed. RESULTS: Significant VAT thresholds were observed for BF%, WHtR, SAT, android BF%, and trunk BF% in both racial groups, with all thresholds higher for Black than White adults. When stratified by sex, all variables showed significant thresholds in White males, while none were observed in Black males. Significant VAT thresholds were identified for BF%, WHR, and SAT in Black females; WHtR in White females; and android-to-gynoid BF% in both groups. CONCLUSIONS: After matching for key anthropometric influences, distinct sex- and race-specific VAT thresholds exist for Black and White adults, often falling below current clinical guidelines. These findings support the need for population-specific screening tools to improve early detection and prevention of cardiometabolic risks.